I am speaking to all of you from the front line here in Italy, mainly in Florence Tuscany. As you all may know, I am a surgeon and emergency physician and, since 2002, the Clinical Risk Manager for the Florence Healthcare Trust. When the COVID-19 outbreak occurred I felt the necessity to go back to front line and help my collegues, nurses and intensivits, and other specialties to treat the enormous amount of COVD-19 positive symptomatic patients in very severe conditions needing invasive ventilation and/or supported by NIV or CPAP procedures.

Dear Colleagues and friends

I am speaking to all of you from the front line here in Italy, mainly in Florence Tuscany. As you all may know, I am a surgeon and emergency physician and, since 2002, the Clinical Risk Manager for the Florence Healthcare Trust. When the COVID-19 outbreak occurred I felt the necessity to go back to front line and help my collegues, nurses and intensivits, and other specialties to treat the enormous amount of COVD-19 positive symptomatic patients in very severe conditions needing invasive ventilation and/or supported by NIV or CPAP procedures.

Believe me, we are experiencing a very dramatic situation and need to be helped and supported. All of us professionals on the front line are exhausted and very tired because we are on the job for many hours and days on a continuous basis. Some of my colleagues haven't been able to leave the hospital since 24th February!!! They are on a continuous shift and dealing with a number of severe respiratory distress cases caused by coronovirus, as severe interstitial pneumonia and deaths are an everyday issue.

On Tuesday, 24th March I have been invited by ISQua to give a Webinar, scheduled at 11:00 a.m. Italian time, to give a testimony of what's happening in my country and specifically in Tuscany. I am very honoured to share my experience.

ISQua and INSH (Italian Network for Safety in Healthcare - Italian ISQua chapter) are about to release a paper of recommendations to healthcare professionals dealing on the front line with COVID patients. This paper will list some general and specific recommendations based on evidence-based data and the experience of frontline workers who everyday give feedback of the situation.

I believe that we all need substantial recommendations ,free of bureaucracy, mainly because we don't have the time to read books or very long papers; we need substantial advice of what to do in terms of self-protection; and psychologically we are all near to burnout status and need psychological support.

I felt the necessity of sharing this with all you prestigious professionals of healthcare worldwide, some of you I had the honour of meeting personally, these everyday issues that are a grief on nurses, doctors and other healthcare workers, besides of course our patients, their families and friends, and the entire Italian healthcare system which is close to a breakdown.

Now, I am aware it has become a global issue, and this means we are farther obliged to support healthcare systems worldwide with practical and concrete suggestions to help decision-making on the front line.

What I have observed in the recent 2 months is a failure in situation awareness and communication leading to a consequent unsuccess of leadership and teamwork. We are now aware of this and trying to struggle to come up with solutions. Our regional government and the patient safety center of Tuscany are trying to support us with organizational strategies which are very hard to realize and we appreciate all the efforts, being myself part of this system; but we experienced a very severe and unjustifiable lack of protection devices for nurses and doctors: a severe lack of masks (all of them), a severe lack of vital supporting devices and many other criticalities and this means that none of the leaders in healthcare institutions dealing with preventive strategies ever took this into consideration.

We also need to reinforce our personnel: we need more doctors and nurses on the front line, and this will also be the need shortly in other countries.

Such a severe pandemic episode should have been foreseen and many data prove this. We are now working under very severe conditions and are exposed to contamination ourselves. Is this a strategic way of dealing with such mass casualty? As Dr Dhingra says in her mail "this is an unprecedented situation", this is correct and I fully agree, I also would like to share with you all a personal consideration: could we have done better? and, as a risk manager may I say: after all this is over and life comes back to routine, what lessons have we learned from this and where should we address improvement strategies.

I apologize for having occupied your time with my considerations but I have been working for the last 8 days continuously, I am tired and need a rest, but I needed to share with all of you my personal experience in this health catastrophe.

My best to all of you and thank you for allowing me to be part of your prestigious organization.

Francesco Venneri, M.D.

Florence Italy

Originally published on 22nd March 2020 as a post to the WHO Global Patient Safety Network.